Saturday, December 15, 2018

Are uterus transplants repugnant? And to whom? And why? (in the Irish Times)

Here's an article in the Irish Times on uterus transplants , that makes clear the view that the views of those not directly involved should play a large  and perhaps decisive role in public discussions of transactions that some may find repugnant. The author indicates that among his concerns is that the parentage of the baby might be in doubt (i.e. that a child conceived from the eggs and sperm of his genetic parents and carried to birth by his pregnant genetic mother might have to be regarded as the child of the donor of the uterus...). I wonder if even the author thinks this is a serious reason to ban uterus transplants; rather, I get the sense that he is throwing his net widely in the hope that different objections might resonate with different parts of his audience. Maybe his goal is simply to be controversial. [Just to be clear, I am not disagreeing that child welfare is an important concern when evaluating issues related to reproduction and childbirth...but this concern strikes me as particularly far-fetched.]

Are uterus transplants ethically acceptable?
Several infertile women worldwide have given birth with wombs received from either living or dead donors   by George Winter

"In September 2014, the first live birth following UTx was reported from Sweden by Prof Mats Brännström and colleagues. The recipient had Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome – she was born without a viable womb – and the donor was a 61-year-old friend. Since then, there have been at least 12 successful births worldwide following UTx.

"Recently, it was revealed that the first baby had been born following a womb transplant from a deceased donor. Ten previous attempts had been made in different countries to deliver a live baby following a uterus or womb transplant from a deceased donor, but this – performed by surgeons in Brazil – was the first with a successful outcome.
"The UTx procedure begins with in-vitro fertilisation, using the recipient’s egg and her partner’s sperm; the subsequent embryo is frozen; a uterus – from a living or dead donor – is transplanted; the embryo is thawed and implanted; and following pregnancy and delivery by Caesarean section, a hysterectomy is performed, obviating the need for lifelong immunosuppressive therapy."
"The “Ethical Considerations” section of the Womb Transplant UK website implies that any societal misgivings on the acceptability of UTx will be ignored: “Ultimately, the decision to go forward will depend on the judgment of the researchers, the participating institution, and most importantly, the patient to whom the transplant will be offered.”
"Hardly an unbiased trio.
"What ethical dilemmas might arise?
"If a transplanted uterus were to jeopardise a recipient’s life, it could be removed; but what if it contains a viable foetus? And there is debate over living versus deceased donation, with Spanish and Japanese teams favouring the Swedish “live” model, and French, Belgian and UK researchers preferring deceased donors. Writing in the journal BioethicsDr Nicola Williams cites the view of the International Federation of Gynaecology and Obstetrics that “the retrieval of a uterus from a living donor necessitates a relatively major surgery with its own risk of complications [and] constitutes reason enough to deem the procedure ethically inappropriate”.
"Also, how much would a child be entitled to know about the donor from whose uterus he or she issued, and – irrespective of whether the donor had been dead or alive – would the infant be the child of the donor or the recipient?"
George Winter, the author of the piece, apparently writes often on ethical issues in medicine (although the above is the first article I had read by him). See e.g.  his recent related articles on The ethical considerations of face transplants and 
The brave new world of wombless gestation--Artificial womb technology poses many ethical questions – we need to debate them
(that article is about experimental technology about lamb embryos brought to term "in a plastic “biobag” – literally, a womb with a view ..."  I was relieved to note that, in considering the implications for humans, the author didn't raise the question above about the parentage--or in this case perhaps the humanity--of the baby (so maybe he was just kidding.)
And see my related post from yesterday:
Friday, December 14, 2018  Successful birth in Brazil to a woman who received a uterus transplanted from a deceased donor

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